Eydawn

And that professional counselor knows what it's like to smell burned flesh and to be exposed to the most raw edges of humanity in the same way that EMS does? Most good pastors don't even bring up God at first when people come to them hurting... they listen and provide validation, and then suggest coping mechanisms. Not too much different from professional psychologist, IMHO. Just saying. Wendy CO EMT-B

So, another tack here... let's look at the dog not as "necessary" in the hospital setting- many of you are quite right that there is no function the dog will perform that human assistants will be unable to while the man is in the hospital. With that mindset, we're simply looking at the dog's trained function, which is to help a person perform tasks they cannot independently complete. Since we're not considering the psychological implications of independence with regard to certain tasks afforded by the man-dog team, let's look at the dog as a valuable piece of property. You don't tell someone they don't need their Porsche keys in the ER, that someone can bring them later, if the person has their keys with them... you don't force someone to leave their expensive belongings on the roadside... if we can establish that the dog can be safely transported, on the liability for cost alone, I would think that you would make sure that person's property is safeguarded whether you liked dogs or not. Hm. Just a new angle that started ticking around in my brain... (It'll do anything to avoid studying for this damn exam...) Wendy CO EMT-B

Wow. Now that's a shitty call. Nobody said that psychological counseling, or pseudo-attempts at such, should be the gold standard for individuals coping with traumatic stressors. Friends, family, religious community, EMTCity... all valid means of coping, and while we don't have stats on whether that can also create issues (as I said before) it's better than bottling everything up. Fact, that's why I went for the CISM training. People talk to me very easily, and we've got some hard core bottle-pressure-POP type folks on my team... so this give me an "official" way to help them de-cork without blowing all over the walls, so to speak... Wendy CO EMT-B

LOL! Helper monkey = hilarious. :-) Needed that laugh, studying my buns off this morning for a peds final... blech. --Wendy

Psychological benefit if not practical use... remember this is an adult with newer onset blindness so very vulnerable and depending on the coping system he has built to deal with it. AKA: the dog... Wendy CO EMT-B

Interesting! I am very familiar with handguns. However, I would not necessarily want to try to clear a gun that I don't know, that I didn't load. If it's in a hip holster, remove the whole holster and place the entire thing in a secured compartment where it won't slide around. Side note- would you want to defib this guy with a gun on his side? That's a huge hunk of metal... that could be problematic, right? Wendy CO EMT-B

Pyschology is a science based largely on the experiences of those who have worked in the field, in some ways. Nonetheless, you must look at statistics. There has been no proven benefit to CISM models. There have been studies indicating that they may cause damage. However, those studies, much like any other study, have been called into contention by those who support CISM. There's a lot of other psychological techniques that carry just as much good/bad dichotomy, and some people choose to support them while others choose not to. Psychology is kind of complex that way. The honest truth is we just don't know enough about CISM to say whether it's truly harmful or beneficial. Much depends on the psychological history of the individual in question. There are more studies demonstrating harm, but those studies involve debriefings that don't fit the currently accepted model. I am a certified CISM debrief technician, for small group and individual settings. I honestly can tell you, the course I took to certify me didn't have any test at the end, nor did it require any large understanding of psychology, which is scary as hell. However, since my team chooses to offer debriefings as part of their model for response to crappy calls, I am there as a resource for those who choose a debriefing. It is seldom. The crux of it is that debriefings must be voluntary, run by at least two individuals with training and must have followup referrals available for individuals who feel that they truly need psychological care. Any "mandatory" debrief run by someone who doesn't know what they're doing is a recipe for disaster. Anyone who thinks they can "prevent PTSD" by offering debriefings doesn't understand psychology. I personally think it's just a more formalized model of the "let's go down to the bar and work through this shitty thing that happened to us" mentality. Some people do well with that. Some people don't. There's no real good studies on informal peer support to say whether it causes the same potential for detrimental effects. If you choose to go to a debriefing, by all means, go for it. You're not an idiot if that's what appeals to you. If you start to show warning signs of post traumatic stress that persist past a few weeks, find a professional counselor that you can have a good working relationship with. Wendy CO EMT-B

"Page not found"- your link is funky... Chbare, what are your concerns with the bioavailability stuff? If you're thinking it's going to take longer, because it's less bioavailable or they're not drawing it in far enough to really hit good absorptive mucus membranes, what's the real concern? Eventually, they will get enough doseage to wake them up enough to have good respiratory control, which is our goal with naloxone, no? So it takes a couple minutes longer... but it is more patient response regulated, as the patient begins to wake up, as opposed to potentially overshooting with the IN or IV route and ending up with a really pissed off patient... Just curious as to what the real concern here is other than extended time and loss of drug- as long as the patient gets the amount necessary to create our desired effect, I don't see what the issue would be. Wendy CO EMT-B

This appears to be directed at mass debriefings of victims, as opposed to the use of small focused group debriefings of responders. Not sure really what to say about this; like many things in psychology, many viewpoints, many approaches... Wendy CO EMT-B

Mobes, you can't spell tonight. OBESE, not OBEICE- it's like you're subconsciously channeling a fat niece or something... lol. The pilot should never have transported passengers without safe seatbelt room. That's all there is to it. Very odd. Wendy CO EMT-B

You didn't read? Really? It's all about the ethics of privacy and confidentiality in the healthcare setting. It doesn't have to qualify as a true HIPAA specific violation to get you shitcanned or otherwise in a world of hurt. This article specifically speaks to the use of social media, but covers pretty heavily the ideas of privacy, confidentiality and boundaries between patient and provider. Don't just skim- go back and take a good read, especially of the scenarios. "Improper use of social media by nurses may violate state and federal laws established to protect patient privacy and confidentiality. Such violations may result in both civil and criminal penalties, including fines and possible jail time. A nurse may face personal liability. The nurse may be individually sued for defamation, invasion of privacy or harassment. Particularly flagrant misconduct on social media websites may also raise liability under state or federal regulations focused on preventing patient abuse or exploitation. If the nurse’s conduct violates the policies of the employer, the nurse may face employment consequences, including termination. Additionally, the actions of the nurse may damage the reputation of the health care organization, or subject the organization to a law suit or regulatory consequences." "Maintain professional boundaries in the use of electronic media. Like in-person relationships, the nurse has the obligation to establish, communicate and enforce professional boundaries with patients in the online environment. Use caution when having online social contact with patients or former patients. Online contact with patients or former patients blurs the distinction between a professional and personal relationship. The fact that a patient may initiate contact with the nurse does not permit the nurse to engage in a personal relationship with the patient." This scenario here really hits it for me- "Jamie has been a nurse for 12 years, working in hospice for the last six years. One of Jamie’s current patients, Maria, maintained a hospital-sponsored communication page to keep friends and family updated on her battle with cancer. Jamie periodically read Maria’s postings, but had never left any online comments. One day, Maria posted about her depression and difficulty finding an effective combination of medications to relieve her pain without unbearable side effects. Jamie knew Maria had been struggling and wanted to provide support, so she wrote a comment in response to the post, stating, “I know the last week has been difficult. Hopefully the new happy pill will help, along with the increased dose of morphine. I will see you on Wednesday.” The site automatically listed the user’s name with each comment. The next day, Jamie was shopping at the local grocery store when a friend stopped her and said, “I didn’t know you were taking care of Maria. I saw your message to her on the communication page. I can tell you really care about her and I am glad she has you. She’s an old family friend, you know. We’ve been praying for her but it doesn’t look like a miracle is going to happen. How long do you think she has left?” Jamie was instantly horrified to realize her expression of concern on the webpage had been an inappropriate disclosure. She thanked her friend for being concerned, but said she couldn’t discuss Maria’s condition. She immediately went home and attempted to remove her comments, but that wasn’t possible. Further, others could have copied and pasted the comments elsewhere. At her next visit with Maria, Jamie explained what had happened and apologized for her actions. Maria accepted the apology, but asked Jamie not to post any further comments. Jamie self- reported to the BON and is awaiting the BON’s decision." The point I'm trying to make here is it doesn't even have to be HIPAA itself that we worry about- there's a whole HOST of confidentiality based issues to worry about. We just focus on HIPAA because it's well publicized. Do we lump too much under it? Sure, but privacy issues are privacy issues, no matter what name we decide to tag them with. Wendy CO EMT-B

By underlying electrolyte issues, are you referring to K+ and the use of insulin to move K+ from blood serum into the intracellular compartment, putting us at risk for serum hypokalemia and cardiac side effects? Or are there others I'm not aware of? Wendy CO EMT-B

I see it both ways. Someone who is handicapped develops entire coping mechanisms to deal with the world that, when removed, profoundly affect their ability to make good decisions or interact to the best of their ability. As patient advocate, aren't we supposed to create the best possible care environment in which our patients can be active participants in their own care? If this blind person has become so dependent on this dog, especially as someone who has lost his sight LATE IN LIFE (much different than being born blind or losing it as a younger child, when you are more adaptable), don't we need to take that into account? Dwayne- tell me, that as the parent of an autistic pre-teen, that you wouldn't fight tooth and nail to keep your kid's service animal with him (especially in a high stress situation) if it allowed him to function to his maximum capacity and be an active participant in his own care... Just saying. I know you would, if it made a difference. Do we owe our patients any less? Now, we could argue that service animals are highly trained, less likely to be a threat to medical providers, and all around better pooches (generalizing to dogs here) to have in your ambulance than the run of the mill untrained mutt. However, if there is some valid reason for not transporting the animal, you better be able to provide reassurance to the individual that you will make provisions for their animal to be safely transported either by PD or animal control to a controlled environment, and that if there are care issues prohibiting the animal's immediate presence in the care environment that the hospital will ensure that the animal will be reunited with the person as soon as is safely possible. You're not going to leave someone's expensive seeing eye, "hearing ear" or seizure dog on the street with nobody to look after them, just like you wouldn't leave a kid sitting there. That's emotionally detrimental to the patient if you refuse to make sure that this valuable companion animal is taken care of, and there's no good reason to do so unless this patient is DYING (but even then, you can enlist the help of bystanders, etc.) Should they have transported the animal? I say it's their discretion. Should they have made sure there was safe, adequate transport and handling of the animal? Absolutely, especially since the patient was totally freaking out about it. Who knows what clinical stuff we're going to miss because we're distracted trying to calm down a freaked out patient. Wendy CO EMT-B

Ooh, Mobes, BURN! LOL Wendy CO EMT-B

Removed her negative. You aren't going to win the "Where's the exact wording damn it all" argument because NOBODY can agree on how to interpret said wording. Stop being a Nazi, and pay attention to the reality of this situation... (said with love, Dwayne...) Now, I know these links are nursing specific, but please take a look at the scenarios listed therein, especially in the first link. HOLY SHIT, they can get you for ANYTHING these days. Some of these are really really innocuous, and yet people were censured by boards of nursing and expelled from school over some of these incidents. https://www.ncsbn.org/Social_Media.pdf http://www.nursingworld.org/socialnetworkingtoolkit Wendy CO EMT-B

This blew my mind. To think that a fetus donates stem cells to repair cardiac damage in a mother... study done in mice. http://blogs.discovermagazine.com/80beats/2011/11/21/helpful-mouse-fetuses-naturally-send-stem-cells-to-mom-to-fix-her-damaged-heart/ Tell me what y'all think! Wendy CO EMT-B

I don't suppose you get problems where it tells you kid's weight or surface area and safe standard doseages for different uses? That's what I'm used to calculating with... You may need to memorize certain drugs and certain "by weight/size" ranges if your problems are set up differently. I just know what we use in nursing school. Wendy CO EMT-B

Was PD automatically dispatched to this call? Do you have standing orders to wait for PD clearance if they are automatically dispatched or are you allowed discretion? Wendy CO EMT-B

See, that's what I'm not clear on. Is this a scene where PD was already dispatched to it, or is it a scene where one medic decided he WANTED to have PD clear it and they requested it? What I'm saying is there's not quite enough information here to make a decision from my viewpoint. Obviously, you err on the side of cops before every OD scene, and agree with the OP's partner. OP- care to clarify? Wendy CO EMT-B

I disagree. Nowhere was it indicated to wait for police arrival based on the information given in this scenario. There's a distinct difference between the cops are also coming and dispatch instructions not to enter until a scene is clear. Sounds like his partner wanted police clearance, not that there were dispatch instructions to that effect. Unless there's standing orders for PD to clear every drug OD, there's definitely grey areas here. It's a moot point anyway- it's the calls you never expect to be shitty that jump out and bite you in the ass... (elderly unwell, enter home, realize about 10 seconds into the living room that there's a pit bull sneaking out from behind the couch who looked PISSED that we're in there... that was a nice objective lesson in scene safety...) I stand by what I said- sounds like there's a different threshhold for comfort here, partner wanted cops, other partner didn't feel it necessary, waited for cops anyway, everyone's alive, time to go home... If you do notice, in my first post in this thread, I did say that you always err on the side of the little voice... whether it's in your head or your partner's head. Gut feelings can save your arse. Wendy CO EMT-B

Looks like your partner's threshold for "I want the cops to clear it first" and yours differ. Nothing wrong with that, and nothing to say who's right or wrong... not worth fighting over. Did the patient die because you waited? Would you have died if there had been a coked out/meth'd out whacko hiding behind the door? All major unknowns in the game of EMS... Wendy CO EMT-B

What did the residence look like? Previous runs there? Lots of OD turned violent calls on your reservation? How many people there when you got there? ETA on police? It's never cut and dry, but this is way too devoid of detail to make a decision on. I agree, however, if your partner felt uncomfortable, you did the right thing by staying. Always listen to that little voice in your head... gut instinct can tell you so much. And, speaking as that person who's just had "a hunch" before and been proven right, listen to the crazy partner unless they're hyper paranoid all the time. It sucks to have to stick yourself out there and say "no really, something's not right here" without an explanation, but boy does it suck if you keep quiet and something happens... Wendy CO EMT-B

Dang... I dunno who's gonna play nice around a grad school schedule, but I'll list off agencies for you that are non-fire in the area... Denver Health: http://www.denverems.org/ Pridemark Paramedics:http://www.pridemark.net/ AMR Denver: http://www.amr.net/Locations/Operations/Colorado/Denver-Boulder.aspx Action Care: http://www.actioncare.com/ Rural Metro: http://www.ruralmetrocolorado.com/ That's all I pretty much know of in the Denver/Boulder area. If you want to come further north or south (Longmont, Weld County, Larimer County, Colorado Springs) PM me and I'll send you more links... I'm in north CO. Wendy CO EMT-B

I say looking ahead is the right thing to do. Don't have much to offer you, but I will say if you pass your paramedic and get hired in a capacity that allows you to pursue the CCP-C then go for it. Welcome to the City! Dive right on in... this is a killer place to expand your understanding of pathophysiology and ethics (to say the least). Come on, y'all. It's not like he's grabbing the books and studying them instead of his paramedic school stuff. You all know I want to work ICU/CCU, but none of you is chastising me telling me to focus on my ADN courses and that I can worry about the BSN stuff later... ;-) Wendy CO EMT-B ADN Student

Well, I was going to say you should read some creative nonfiction to just broaden your reading horizons a little, but the book I was going to suggest was The Help. As it has directly to do with civil rights in that contextual era, no dice... Sounds like you have no idea what you want, and want us to give it to you, but only if you're already interested ;-) What about some biomedical ethics stuff? --Wendy